Provider Demographics
NPI:1396091658
Name:ROTHMEYER, JANICE CAROL (LCPC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:CAROL
Last Name:ROTHMEYER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1513
Mailing Address - Country:US
Mailing Address - Phone:208-263-5393
Mailing Address - Fax:208-265-2301
Practice Address - Street 1:506 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1513
Practice Address - Country:US
Practice Address - Phone:208-263-5393
Practice Address - Fax:208-265-2301
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3694101Y00000X
IDLCPC6264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1427179746Medicaid